Exercise Snacks for Type 2 Diabetes

Overseen By Jonathan P Little, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of British Columbia

Must not be taking: Beta-blockers

Disqualifiers: Cardiac disease, Hypertension, Psychiatric disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 12 weeks

80 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must be on a stable dose of up to 3 glucose-lowering medications (not including insulin) and up to 2 cardiovascular medications for more than 6 months to participate.

What data supports the effectiveness of the treatment 'Exercise Snacks' for Type 2 Diabetes?

Research shows that regular physical exercise, including small doses of intense exercise before meals, can improve blood sugar control and increase insulin sensitivity in people with type 2 diabetes. Exercise is also known to reduce body fat, improve heart health, and enhance overall fitness, making it a beneficial treatment for managing diabetes. ^{1 2 3 4 5}

Is it safe for humans to participate in exercise snacks or similar physical activity interventions?

Exercise snacks and similar physical activities are generally safe for humans, but it's important to monitor glucose levels, especially for people with diabetes. Light to moderate exercise is recommended, while high-intensity exercise may cause wide glucose fluctuations. People with diabetes should consult healthcare providers to tailor exercise plans to their specific needs and conditions. ^{1 2 6 7 8}

How is the 'Exercise Snacks' treatment different from other treatments for type 2 diabetes?

The 'Exercise Snacks' treatment is unique because it involves short, intense bursts of exercise before meals, which can improve blood sugar control more effectively than longer, moderate exercise sessions. This approach is convenient, easy to implement, and helps reduce sedentary time, making it a practical option for people with busy schedules. ^{1 2 4 9 10}

What is the purpose of this trial?

To conduct a pilot randomized control trial to determine the feasibility of a 12-week, technology-enabled exercise snacks intervention in adults living with type 2 diabetes in a real-world setting. We will also assess preliminary efficacy based on measures of glycemic control and fitness.

Research Team

Jonathan Little, PhD

Principal Investigator

University of British Columbia

Eligibility Criteria

Adults aged 30-75 with type 2 diabetes, HbA1c ≤8.5%, physically inactive, and not on extreme diets or certain medications can join this study. They must be able to use technology for the program and not have conditions like severe heart disease, recent cardiovascular events, or psychiatric disorders that interfere with exercise.

Inclusion Criteria

HbA1c ≤8.5%

Able to maintain current physical activity patterns during the study

Physically inactive (performing <150 min moderate-to-vigorous physical activity per week)

Exclusion Criteria

I am taking beta-blockers that may affect heart rate tests.

Angina upon exertion assessed by the Rose Angina Questionnaire

I have a heart or lung condition that stops me from exercising.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-intervention Meeting

Participants have a meeting to document physical limitations and discuss the prescribed intervention

1 week

1 visit (in-person or virtual)

Treatment

Participants perform either vigorous-intensity bodyweight exercises or low-intensity stretching exercises for 12 weeks

12 weeks

Delivered via app or web platform

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

1 visit (in-person)

Treatment Details

Interventions

• Exercise Snacks

Trial Overview The trial is testing 'exercise snacks,' short bursts of physical activity facilitated by technology over a period of 12 weeks. Participants are randomly placed into two groups: one doing these exercises and another performing placebo activities to compare effects on blood sugar control and fitness.

Participant Groups

Group I: Exercise Snacks Experimental Treatment 1 Intervention

Vigorous-intensity bodyweight exercises performed 4 times per day on at least 5 days per week.

Group II: Placebo Exercise Active Control 1 Intervention

Low-intensity stretching exercises performed 4 times per day on at least 5 days per week.

Who Is Running the Clinical Trial?

University of British Columbia

Lead Sponsor

Trials

1,506

Recruited

2,528,000+

McMaster University

Collaborator

Trials

936

Recruited

2,630,000+

Findings from Research

Short bursts of intense exercise ('exercise snacks') before meals significantly improved blood glucose control in individuals with insulin resistance, showing a reduction in post-meal glucose levels compared to traditional continuous exercise.

Both exercise snacking and a combination of exercise snacking with resistance training were equally effective in lowering overall glucose levels, suggesting that brief, intense workouts can be a practical strategy for managing blood sugar.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

'Exercise snacks' before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance. Francois, ME., Baldi, JC., Manning, PJ., et al.[2022]

Regular physical exercise is crucial for both preventing and treating type 2 diabetes, leading to benefits such as improved insulin sensitivity, better glycemic control, and enhanced cardiovascular health.

Before starting an exercise program, individuals with type 2 diabetes should undergo a thorough medical evaluation to assess their cardiovascular health and any complications, ensuring a safe and effective exercise plan that gradually increases in intensity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diet and exercise in type 2 diabetes mellitus. Hamdy, O., Goodyear, LJ., Horton, ES.[2019]

In a 3-year study involving 300 patients with type 2 diabetes, behavioral counseling led to significant increases in physical activity and decreases in sedentary time, which were associated with improved physical fitness and reduced cardiovascular risk factors.

Modest increases in moderate- to vigorous-intensity physical activity (MVPA) resulted in clinically meaningful improvements, such as a decrease in HbA1c levels and enhanced cardiorespiratory fitness, highlighting the importance of even small changes in activity levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2). Balducci, S., Haxhi, J., Sacchetti, M., et al.[2023]

In a study involving six patients with type 2 diabetes, three types of 20-minute moderate-intensity exercises (WB-EMS, RES, and END) were found to reduce postprandial glucose levels after meals, indicating that exercise can help manage blood sugar spikes.

While all exercise types showed similar effects on glucose levels over time, cycling endurance exercise (END) suggested a potential superior effect during the post-exercise recovery phase, although this was not statistically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Acute Resistance Exercise with and without Whole-Body Electromyostimulation and Endurance Exercise on the Postprandial Glucose Regulation in Patients with Type 2 Diabetes Mellitus: A Randomized Crossover Study. Holzer, R., Schulte-Körne, B., Seidler, J., et al.[2022]

High-intensity training has been shown to significantly improve metabolic parameters in patients with pre-diabetes and type 2 diabetes, highlighting the importance of exercise therapy for glycemic control.

For patients unable to engage in traditional exercise due to complications, non-exercise activity thermogenesis (NEAT) can be beneficial, providing an alternative way to enhance metabolic health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise Therapy for Patients With Type 2 Diabetes: A Narrative Review. Yanai, H., Adachi, H., Masui, Y., et al.[2020]

Light aerobic exercise for 60 minutes or moderate exercise for 20-30 minutes, starting 30 minutes after a meal, can effectively reduce postmeal glucose surges with minimal risk of hypoglycemia, based on a review of 39 studies over 30 years.

Incorporating moderate-intensity resistance exercise 2-3 times a week can further help in managing glucose levels, while high-intensity exercise may lead to unpredictable glucose fluctuations and requires further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercising Tactically for Taming Postmeal Glucose Surges. Chacko, E.[2023]

In a study involving five insulin-dependent diabetics, exercising after fasting led to stable plasma glucose levels during exercise, but hypoglycemia occurred 1 to 2 hours post-exercise, highlighting the need for effective pre-exercise snacks.

Three different pre-exercise snacks (orange juice, whole milk, and skim milk) containing 13 g of carbohydrates were effective in preventing hypoglycemia, with orange juice and skim milk providing quicker glucose absorption and higher plasma glucose levels during exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Programming pre-exercise snacks to prevent post-exercise hypoglycemia in intensively treated insulin-dependent diabetics. Nathan, DM., Madnek, SF., Delahanty, L.[2019]

Exercise can greatly benefit people with diabetes, but it's crucial to measure glucose levels before starting to ensure safety during workouts.

Guidelines have been developed to help exercise specialists determine when to start or stop exercise based on glucose levels, with specific contraindications such as low glucose (<4.0 mmol/L) or high glucose (>15.0 mmol/L with symptoms).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resources to Guide Exercise Specialists Managing Adults with Diabetes. Turner, G., Quigg, S., Davoren, P., et al.[2020]

Individuals with impaired fasting glucose (IFG) had consistently higher glucose levels compared to healthy individuals after consuming different preexercise snacks, indicating a potential risk for glucose management in this population.

Raisins as a preexercise snack resulted in lower post-exercise glucose and insulin responses compared to a glucose solution, suggesting that they may be a better option for managing blood sugar levels in people with IFG.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Glycemic and insulinemic responses to different preexercise snacks in participants with impaired fasting glucose. Byrne, HK., Kim, Y., Hertzler, SR., et al.[2019]

Exercise snacks, which are short bursts of physical activity, can effectively reduce sedentary behavior and promote regular exercise habits, making them a practical solution for overcoming barriers to physical activity.

Research shows that exercise snacks are safe and beneficial for various populations, including the elderly and individuals with obesity or diabetes, as they improve physical function, reduce fall risk, and enhance cardiorespiratory fitness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Applying an Exercise Snack-Based Health Promotion Strategy]. Huang, CH., Yen, M.[2023]

References

1. Germany pubmed.ncbi.nlm.nih.gov

'Exercise snacks' before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Diet and exercise in type 2 diabetes mellitus. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2). [2023]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Effects of Acute Resistance Exercise with and without Whole-Body Electromyostimulation and Endurance Exercise on the Postprandial Glucose Regulation in Patients with Type 2 Diabetes Mellitus: A Randomized Crossover Study. [2022]

5. Canada pubmed.ncbi.nlm.nih.gov

Exercise Therapy for Patients With Type 2 Diabetes: A Narrative Review. [2020]

6. Egypt pubmed.ncbi.nlm.nih.gov

Exercising Tactically for Taming Postmeal Glucose Surges. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Programming pre-exercise snacks to prevent post-exercise hypoglycemia in intensively treated insulin-dependent diabetics. [2019]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Resources to Guide Exercise Specialists Managing Adults with Diabetes. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Glycemic and insulinemic responses to different preexercise snacks in participants with impaired fasting glucose. [2019]

10. China (Republic : 1949- ) pubmed.ncbi.nlm.nih.gov

[Applying an Exercise Snack-Based Health Promotion Strategy]. [2023]